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Silent hypoxia is not an identifiable characteristic in patients with COVID-19 infection

BACKGROUND: We aimed to assess whether asymptomatic (“happy”) hypoxia was an identifiable physiological phenotype of COVID-19 acute respiratory distress syndrome (ARDS), and associated with need for ICU admission. METHODS: We performed an observational cohort study of all adult patients admitted wit...

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Autores principales: Plummer, Nicholas Russell, Fogarty, Andrew, Shaw, Dominick, Card, Timothy, West, Joe, Crooks, Colin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier Ltd. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9047547/
https://www.ncbi.nlm.nih.gov/pubmed/35490510
http://dx.doi.org/10.1016/j.rmed.2022.106858
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author Plummer, Nicholas Russell
Fogarty, Andrew
Shaw, Dominick
Card, Timothy
West, Joe
Crooks, Colin
author_facet Plummer, Nicholas Russell
Fogarty, Andrew
Shaw, Dominick
Card, Timothy
West, Joe
Crooks, Colin
author_sort Plummer, Nicholas Russell
collection PubMed
description BACKGROUND: We aimed to assess whether asymptomatic (“happy”) hypoxia was an identifiable physiological phenotype of COVID-19 acute respiratory distress syndrome (ARDS), and associated with need for ICU admission. METHODS: We performed an observational cohort study of all adult patients admitted with hypoxaemic respiratory failure to a large acute hospital Trust serving the East Midlands, UK. Patients with confirmed COVID-19 were compared to those without. Physiological response to hypoxaemia was modelled using a linear mixed effects model. RESULTS: Of 1,586 patients included, 75% tested positive for SARS-CoV-2. The ROX index was 2.08 min(−1) lower (1.56–2.61, p < 0.001) in the COVID-19 cohort when adjusted for age and ethnicity, suggesting an enhanced respiratory response to hypoxia compared to the non-Covid-19 patients. There was substantial residual inter- and intra-patient variability in the respiratory response to hypoxaemia. 33% of the infected cohort required ICU, and of these 31% died within 60 days. ICU admission and mortality were both associated with an enhanced respiratory response for all degrees of hypoxaemia. CONCLUSIONS: Patients with COVID-19 display a more symptomatic phenotype in response to hypoxaemia than those with other causes of hypoxaemic respiratory failure, however individual patients exhibit a wide range of responses. As such although asymptomatic hypoxaemia may be a phenomenon in any individual patient with hypoxaemic respiratory failure, it is no more frequently observed in those with SARS-CoV-2 infection than without.
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spelling pubmed-90475472022-04-29 Silent hypoxia is not an identifiable characteristic in patients with COVID-19 infection Plummer, Nicholas Russell Fogarty, Andrew Shaw, Dominick Card, Timothy West, Joe Crooks, Colin Respir Med Original Research BACKGROUND: We aimed to assess whether asymptomatic (“happy”) hypoxia was an identifiable physiological phenotype of COVID-19 acute respiratory distress syndrome (ARDS), and associated with need for ICU admission. METHODS: We performed an observational cohort study of all adult patients admitted with hypoxaemic respiratory failure to a large acute hospital Trust serving the East Midlands, UK. Patients with confirmed COVID-19 were compared to those without. Physiological response to hypoxaemia was modelled using a linear mixed effects model. RESULTS: Of 1,586 patients included, 75% tested positive for SARS-CoV-2. The ROX index was 2.08 min(−1) lower (1.56–2.61, p < 0.001) in the COVID-19 cohort when adjusted for age and ethnicity, suggesting an enhanced respiratory response to hypoxia compared to the non-Covid-19 patients. There was substantial residual inter- and intra-patient variability in the respiratory response to hypoxaemia. 33% of the infected cohort required ICU, and of these 31% died within 60 days. ICU admission and mortality were both associated with an enhanced respiratory response for all degrees of hypoxaemia. CONCLUSIONS: Patients with COVID-19 display a more symptomatic phenotype in response to hypoxaemia than those with other causes of hypoxaemic respiratory failure, however individual patients exhibit a wide range of responses. As such although asymptomatic hypoxaemia may be a phenomenon in any individual patient with hypoxaemic respiratory failure, it is no more frequently observed in those with SARS-CoV-2 infection than without. Elsevier Ltd. 2022-06 2022-04-26 /pmc/articles/PMC9047547/ /pubmed/35490510 http://dx.doi.org/10.1016/j.rmed.2022.106858 Text en © 2022 Elsevier Ltd. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Original Research
Plummer, Nicholas Russell
Fogarty, Andrew
Shaw, Dominick
Card, Timothy
West, Joe
Crooks, Colin
Silent hypoxia is not an identifiable characteristic in patients with COVID-19 infection
title Silent hypoxia is not an identifiable characteristic in patients with COVID-19 infection
title_full Silent hypoxia is not an identifiable characteristic in patients with COVID-19 infection
title_fullStr Silent hypoxia is not an identifiable characteristic in patients with COVID-19 infection
title_full_unstemmed Silent hypoxia is not an identifiable characteristic in patients with COVID-19 infection
title_short Silent hypoxia is not an identifiable characteristic in patients with COVID-19 infection
title_sort silent hypoxia is not an identifiable characteristic in patients with covid-19 infection
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9047547/
https://www.ncbi.nlm.nih.gov/pubmed/35490510
http://dx.doi.org/10.1016/j.rmed.2022.106858
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